Volume versus substance?

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sophiejane

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This is a question for those of you on The Other Side of residency.

I found a program that I love, and they love me (program A). It was pretty much a done deal until my last interview at program B.

Program B is widely considered the "best" in the state and one of the best unopposed programs in the country. The volume is very high, the patients are very sick, and procedures are plentiful.

Program A is smaller, but is known for excellent teaching. The volume is probably about 2/3 of what it is at program A, and there is also a nice variety of pathology, though not what they see at program B. You have to work for procedures, i.e., ask the ER to page you for intubations and central lines, or do a "procedure rotation" in 3rd year.

Program B would mean moving to a city that would put considerable strain on my family. Program A is much closer to home and is in a city both my husband and I really like.

I want to do rural medicine (real rural, like 1-2 hours from the city), and I want to either do OB, or find a niche with colonoscopies and vasectomies. My perfect practice would include a day of procedures, 3 days of clinic, and an ER shift (I know, I'm dreaming).

Program B has a reputation for producing rural docs, and hospitals actively recruit their grads. Program A also produces rural docs, some of whom have thriving OB practices, but it's not as well known.

If you are still reading...my question is: for rural medicine, is it better to gain a deeper understanding of complex medical problems with more time to be thorough and really understand your patients (program A), or is it better to get high volume and learn by sheer quantity?

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If you are still reading...my question is: for rural medicine, is it better to gain a deeper understanding of complex medical problems with more time to be thorough and really understand your patients (program A), or is it better to get high volume and learn by sheer quantity?

I don't think this answer applies solely to rural medicine. IMO, you'll learn more at a program where you're happy. Case volume alone won't make up for it if you're not. This is assuming, of course, that neither program is truly deficient in terms of volume and learning opportunities, which it doesn't sound like they are.

It would appear to me that your "Program A" is still the way to go. :)
 
hey sophiejane...just wondering..im from texas and are you talking about JPS and methodist? i am actually from houston and IV at baylor and really loved it and will probably be going there but also IV at those other two places and they both seem good..JPS...is known to produce more rural docs and i have a few friends there that say they love it and learn so much...great teaching and you see alot. If you have any questions maybe i can ask some of my friends about the programs.
 
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I want to do rural medicine (real rural, like 1-2 hours from the city), and I want to either do OB, or find a niche with colonoscopies and vasectomies. My perfect practice would include a day of procedures, 3 days of clinic, and an ER shift (I know, I'm dreaming).

My dream practice! :love:
 
I don't think this answer applies solely to rural medicine. IMO, you'll learn more at a program where you're happy. Case volume alone won't make up for it if you're not. This is assuming, of course, that neither program is truly deficient in terms of volume and learning opportunities, which it doesn't sound like they are.

It would appear to me that your "Program A" is still the way to go. :)

Have you been talking to my mom?? ;)

I know...heart is saying A, head is saying B....in the end, as usual with me, heart will probably win...
 
I don't think this answer applies solely to rural medicine. IMO, you'll learn more at a program where you're happy.

This advice needs to be broadcast everywhere. Why is it that in medicine, it seems, that one's happiness is barely given consideration, if at all?
 
This advice needs to be broadcast everywhere. Why is it that in medicine, it seems, that one's happiness is barely given consideration, if at all?

It's true, and even I, who have been so pleased with myself to this point for keeping balance in my life, have fallen victim to the notion that unless I am working to the point of exhaustion, I must not be learning enough.

I already feel this tremendous responsibility to my future patients, and worry that if I choose the wrong program, I could be selling myself and them short. It's crazy, I know, but these are the thoughts that go through the mind of a 4th year as February looms....
 
I would choose program A. It sounds like a good program from your description and it's also near your family. Family can be a major source of support during residency training. (I've been away from my family for 9 years and I think I could have thrived more if I was closer to home). I wouldn't pick a weak program though simply b/c it is closer to family. However, program A doesn't sound like that.

Good luck with your decision! :luck:
 
I wouldn't pick a weak program though simply b/c it is closer to family. However, program A doesn't sound like that.

You're right. Fortunately, my decision at this point is between a very good program and a better program. Weak is not even in the cards--I did my research before applying!
 
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